National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil.
National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil; Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Value Health. 2020 Jun;23(6):812-823. doi: 10.1016/j.jval.2020.02.004. Epub 2020 May 26.
Implementation of value-based initiatives depends on cost-assessment methods that can provide high-quality cost information. Time-driven activity-based costing (TDABC) is increasingly being used to solve the cost-information gap. This study aimed to review the use of the TDABC methodology in real-world settings and to estimate its impact on the value-based healthcare concept for inpatient management.
This systematic review was conducted by screening PubMed/MEDLINE and Scopus databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, including all studies up to August 2019. The use of TDABC for inpatient management was the main eligibility criterion. A qualitative approach was used to analyze the different methodological aspects of TDABC and its effective contribution to the implementation of value-based initiatives.
A total of 1066 studies were retrieved, and 26 full-text articles were selected for review. Only studies focused on surgical inpatient conditions were identified. Most of the studies reported the types of activities on a macrolevel. Professional and structural cost variables were usually assessed. Eighteen studies reported that TDABC contributed to value-based initiatives, especially cost-saving findings. TDABC was satisfactorily applied to achieve value-based contributions in all the studies that used the method for this purpose.
TDABC could be a strategy for increasing cost accuracy in real-world settings, and the method could help in the transition from fee-for-service to value-based systems. The results could provide a clearer idea of the costs, help with resource allocation and waste reduction, and might support clinicians and managers in increasing value in a more accurate and transparent way.
基于价值的举措的实施取决于能够提供高质量成本信息的成本评估方法。时间驱动作业成本法（TDABC）越来越多地被用于解决成本信息差距问题。本研究旨在回顾 TDABC 方法在现实环境中的应用，并评估其对基于价值的医疗保健概念在住院管理中的影响。
本系统评价通过筛选 PubMed/MEDLINE 和 Scopus 数据库，按照系统评价和荟萃分析报告的首选条目进行，包括截至 2019 年 8 月的所有研究。TDABC 用于住院管理是主要的入选标准。采用定性方法分析 TDABC 的不同方法学方面及其对基于价值举措实施的有效贡献。
共检索到 1066 项研究，选择了 26 篇全文文章进行审查。仅确定了针对外科住院条件的研究。大多数研究报告了宏观层面的活动类型。通常评估专业和结构成本变量。有 18 项研究报告称 TDABC 有助于基于价值的举措，特别是节省成本的发现。在所有为该目的使用该方法的研究中，TDABC 都被满意地应用于实现基于价值的贡献。
TDABC 可能是提高现实环境中成本准确性的一种策略，该方法有助于从按服务收费向基于价值的系统转变。结果可以更清楚地了解成本，有助于资源分配和减少浪费，并可能支持临床医生和管理人员以更准确和透明的方式增加价值。
